This document discusses vertigo, providing information on: 1) Differential diagnoses for vertigo including peripheral vestibular dysfunction, central brainstem lesions, presyncope, psychiatric disorders, and unknown causes. 2) Peripheral vs central causes of vertigo based on factors like onset, severity, positional nature, intermittency, and presence of nystagmus, otologic, or neurologic findings. 3) Common peripheral causes of vertigo including BPPV (canalithiasis), vestibular neuronitis, Meniere's disease, and trauma. Common central causes include vascular issues and demyelinating diseases.

1. 1

2. VERTIGO
B.Barati
Otorhinolaryngologist
Otologist, Neuro-otologist
Associate professor
Shahid Beheshti Medical University

4. Differential
• 40% Peripheral vestibular
dysfunction
• 10% Central brainstem vestibular
lesion
• 25% Presyncope or disequilibrium
• 15% Psychiatric disorder
• 10% Unknown cause

7. Peripheral Vestibular System

8. Peripheral vs Central Vertigo
• Onset
• Severity
• Positional
• Intrmitant
• Otologic findings
• Neurologic findings
• Nystagmus

9. Nystagmus
F a s t p h a s e
Toward dominant ear
C O W S
H o r i z o n t a l , T o r s i o n a l
F i x a t i o n s u p p r e s s i o n

10. Peripheral vs Central Vertigo

11. Vestibular dysfunction...
Peripheral causes
canalithiasis (BPPV) -
- 50%
vestibular neuronitis
(labyrinthitis) -- 25%
Meniere’s disease --
10%
trauma
drugs
(aminoglycosides)
Central causes
vascular
(vertebrobasilar
insufficiency) -- 50%
demyelinating
(multiple sclerosis)
drugs
(anticonvulsants,
alcohol, hypnotics)

12. Benign paroxysmal positional vertigo

16. Dix-Hallpike

17. Dix-Hallpike

28. Other Tx
• Medical
• Surgical

29. Meniere’s Disease